Grief Questionnaire

Please answer the following questions. For multiple choice questions where only one answer is required, select the answer that describes what happens most often. If you have trouble selecting just one answer, please narrow it down to a couple of possible answers, and then select the one that applies to you the most or most often.

For questions where multiple answers are acceptable, please check as many as apply to your situation.

1) Memories of the person who died or left upset me greatly.

Never

Rarely

Sometimes

Often

Very Often / Always

2) I think about this person so much that it's hard for me to do the things I normally do.

Never

Rarely

Sometimes

Often

Very Often / Always

3) I feel I cannot accept the loss of the person who died or left.

Never

Rarely

Sometimes

Often

Very Often / Always

4) I feel myself longing for the person who died or left.

Never

Rarely

Sometimes

Often

Very Often / Always

5) I feel drawn to the places and things associated with the person who's gone.

Never

Rarely

Sometimes

Often

Very Often / Always

6) I can't help feeling angry about his/her death or leaving.

Never

Rarely

Sometimes

Often

Very Often / Always

7) I feel disbelief over what happened.

Never

Rarely

Sometimes

Often

Very Often / Always

8) I feel stunned or dazed over what happened.

Never

Rarely

Sometimes

Often

Very Often / Always

9) Ever since he/she died or left, it is hard for me to trust people.

Never

Rarely

Sometimes

Often

Very Often / Always

10) Ever since he/she died or left, I feel as if I have lost the ability to care about other people or I feel distant from people I care about.

Never

Rarely

Sometimes

Often

Very Often / Always

11) I feel lonely a great deal of the time ever since the loss.

Never

Rarely

Sometimes

Often

Very Often / Always

12) I have pain in the same area of my body or have some of the same symptoms as the person who died.

Never

Rarely

Sometimes

Often

Very Often / Always

13) I go out of my way to avoid reminders of the person who's gone.

Never

Rarely

Sometimes

Often

Very Often / Always

14) I feel that life is empty without the person who died or left.

Never

Rarely

Sometimes

Often

Very Often / Always

15) I hear the voice of the person who's no longer in my life speak to me.

Never

Rarely

Sometimes

Often

Very Often / Always

16) I see the person who's gone stand before me.

Never

Rarely

Sometimes

Often

Very Often / Always

17) I feel that it is unfair that I should live when this person died or left.